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McLaren Health Care Coder III in Shelby Township, Michigan

Description

Position Summary:

Remote position responsible for coding complex hospital outpatient records (Outpatient Coder III) review documentation and properly identifies and assigns ICD-10-CM, CPT/HCPCS and/or PCS codes for all reportable diagnoses and procedures. This includes determining the correct principal diagnosis, co-morbidities and complications, secondary conditions and surgical procedures.

This includes utilizing technical coding principals and APR and/or MS-DRG reimbursement expertise to assign appropriate ICD-10-CM diagnoses and PCS procedures, as well as abstracting these code assignments according to facility guidelines. Works collaboratively with CDI, understand Potentially Preventable Complications (PPC’s)/ Hospital Acquired Conditions (HAC’s), Prevention Quality Indicators (PQI’s) to ensure accurate APR-DRG/SOI/ROM and their impact and other indicators as needed. This includes utilizing technical coding principals and APC reimbursement expertise to assign appropriate ICD-10-CM diagnoses and CPT procedures, as well as abstracting these code assignments according to facility guidelines

Essential Functions and Responsibilities:

  • Coding experience of:

  • Outpatient Coder III will be responsible for coding and charge validation (charge entry):

  • Observation, Complex Same Day Surgery, Infusion, or

  • Cath lab, IR, or

  • Hem/ONC, Rad/ONC, or

  • Procedure coding for Pain Management, Wound Care or

  • Professional Specialty Coding, Specialty Surgery or

  • CCI/NCCI Edits and Denials expert knowledge, inclusive of review and resolution of pre-bill and post-bill edits, inclusive of review of denials and writing appeal letters

  • Inpatient Coder III will be responsible for coding:

  • Complex Inpatient visits (inclusive of < 30 days of LOS and >30 days of LOS)

  • Denials and Appeals expert knowledge, inclusive of review and resolution of pre-bill and post-bill edits, inclusive of review of denials and writing appeal letters

  • Expert ability to review outpatient medical record documentation and accurately assigns appropriate ICD-10-CM codes for all reportable diagnoses and assigns/validates CPT codes for procedures.

  • Expert ability to ensure assigned codes must support the reason for the visit and the medical necessity that is documented by the provider to support the care provided

  • Expert ability to apply (charge enter) appropriate soft codes for evaluation and management level(s), observation hours, injections, infusions, and other procedures as necessary

  • Expert ability to validate CPT codes (charges) captured by McLaren departments such as hard-coded charges for services provided on specific encounters.

  • Expert ability to correctly abstract required data per facility specifications.

  • Expert ability to perform medical necessity for Medicare and other payers as required per payment guidelines.

Qualifications

Required:

  • Associates degree in HIT or closely related field

  • Five years of Facility Inpatient or Outpatient Coding experience.

  • RHIT (Registered Health Information Technician (AHIMA) or CCS (Certified Coding Specialist (AHIMA) certification

Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

Job: Non-Health Professional

Primary Location: Michigan-Shelby Township-McL Central Bus Office

Organization MHC00-McLaren Health Care

Employee Status Regular

Shift Day Job

Job Type Standard

Schedule Full-time

Req ID: 22007915

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